嗜铬细胞瘤根治性手术后的心脏改变及其逆转：PheoCard 前瞻性队列研究。

Cardiac Changes and Their Reversal Following Curative Surgery in Pheochromocytoma: PheoCard Prospective Cohort Study.

机构信息

Department of Endocrine & Breast Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226014, India.

Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226014, India.

出版信息

World J Surg. 2023 Feb;47(2):304-311. doi: 10.1007/s00268-022-06731-6. Epub 2022 Oct 10.

DOI:10.1007/s00268-022-06731-6

PMID:36210362

Abstract

BACKGROUND

Pheochromocytoma and paraganglioma (PPGL) are catecholamine producing tumors of chromaffin cell origin, known to cause varied cardiovascular manifestations from hypertension to myocardial infarction. This study sought to objectively evaluate the cardiac changes in PPGL patients and their reversal following curative surgery.

METHODS

The PheoCard study was registered in ClinicalTrials.gov (NCT05082311) and involved 35 consecutive PPGL patients managed as per standard protocol involving alpha blockade followed by curative surgery. They underwent detailed cardiac evaluation using 2D-echocardiography and speckle tracking echocardiography at the time of diagnosis, 7-10 days after alpha blockade, and at 7 days, 3 months, and 6 months after surgical removal. Age- and gender-matched essential hypertensives and healthy individuals (10 in each group) served as two control groups.

RESULTS

Patients with PPGLs had significantly higher mean blood pressure, left ventricle end-diastolic dimension and volume (LVEDD, LVEDV), left ventricle end-systolic volume (LVESV), septal wall thickness, LV hypertrophy, lower mean LV ejection fraction (LVEF), early diastolic mitral annular velocity (E/A), decreased amplitude of LV longitudinal strain, and increased circumferential strain (p < 0.001) when compared with the control groups at baseline. After alpha blockade, there was marked reduction in the mean LVEDD, LVEDV, LVESV, and normalization of E/A ratio (p < 0.001) in the PPGL patients. Following curative surgery (normalization of fractionated urinary metanephrines at 7-10 days post-operatively), there was early improvement in all echocardiographic parameters and it continued to improve even at 6 months after surgery. There was marked improvement in the global longitudinal strain as seen on serial speckle tracking echocardiography with recovery of most of the segments of LV depicting the reversal of subclinical endocardial dysfunction (p < 0.001).

CONCLUSION

PPGL patients despite normal systolic function have subclinical LV diastolic dysfunction which is reversed after curative surgery.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05082311.

摘要

背景

嗜铬细胞瘤和副神经节瘤（PPGL）是起源于嗜铬细胞的儿茶酚胺产生肿瘤，已知会引起从高血压到心肌梗死等各种心血管表现。本研究旨在客观评估 PPGL 患者的心脏变化及其在根治性手术后的逆转情况。

方法

PheoCard 研究已在 ClinicalTrials.gov 注册（NCT05082311），纳入了 35 名按标准方案治疗的连续 PPGL 患者，该方案包括α受体阻滞剂治疗，随后进行根治性手术。他们在诊断时、α受体阻滞剂治疗后 7-10 天、手术后 7 天、3 个月和 6 个月时，使用二维超声心动图和斑点追踪超声心动图进行详细的心脏评估。年龄和性别匹配的原发性高血压患者和健康个体（每组 10 名）作为两个对照组。

结果

PPGL 患者的平均血压、左心室舒张末期内径和容量（LVEDD、LVEDV）、左心室收缩末期容积（LVESV）、室间隔厚度、左心室肥厚、平均左心室射血分数（LVEF）、二尖瓣环早期舒张速度（E/A）、左心室纵向应变幅度降低和圆周应变增加（p<0.001）均显著高于对照组。在接受α受体阻滞剂治疗后，PPGL 患者的平均 LVEDD、LVEDV、LVESV 显著降低，E/A 比值恢复正常（p<0.001）。在根治性手术后（术后 7-10 天尿液中游离甲氧基肾上腺素正常），所有超声心动图参数均早期改善，甚至在术后 6 个月时仍持续改善。在连续斑点追踪超声心动图上观察到整体纵向应变显著改善，左心室大部分节段的功能恢复，表明亚临床心内膜功能障碍得到逆转（p<0.001）。